'Taking it one day at a time' and 'Reaching back out to help someone': How transgender women living with HIV and community stakeholders navigate violence, oppression, and health through coping and advocacy.

Background: Transgender women living with HIV face intersectional oppression resulting in consequences for their mental and physical health. Interventions are needed that center the voices of transgender women living with HIV (TWLWH) and community stakeholders engrossed in work on behalf of the transgender community through advocacy and/or work roles.

Methods: Through a partnership with a trans led and focused program of a community-based health organization and an academic partner, from October 2020 through October 2021, TWLWH and community stakeholders participated in qualitative interviews on trauma, violence, mental health struggles, HIV stigma, gender discrimination, health behaviors (e.g., medication adherence), and their thoughts and recommendations for a proposed intervention. Using a virtual platform (i.e., Zoom or phone) TWLWH and stakeholders were administered a demographics survey via Research Electronic Data Capture (REDCap) and completed individual interviews that were audio recorded. These interviews were analyzed using thematic content analysis.

Results: All TWLWH and 50% of stakeholders were Black. Qualitative findings highlighted the magnitude of violence, stigma, and discrimination faced by TWLWH and the mental, physical, and economic consequences. Also highlighted were the adaptive strategies TWLWH are utilizing to cope, ways in which invested stakeholders (many of lived expertise) are showing up for women, and acceptability and valuable insights for a proposed intervention.

Conclusion: TWLWH are navigating a hostile society and multilevel interventions (at the structural, community, interpersonal, and individual levels) centering their voices and those invested in advocating for the community are needed to address the sequelae of oppression they face.